Outcomes of Mitrofanoff revisionary procedures with follow-up of at least 5 years after initial revision.
Michael Daugherty, MD, Zehra Kazmi, MD, Andrew Strine, MD, Paul Noh, MD, William R. DeFoor, MD, Eugene Minevich, MD, Curtis Sheldon, MD, Pramod Reddy, MD, Brian VanderBrink, MD.
Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
The Mitrofanoff channel is an effective means to manage patients with neurogenic bladder; however, complications may occur that may require surgical revision. Little is known regarding the long-term outcomes following such revisionary procedures. We aim to describe the long-term outcomes of an initial Mitrofanoff revision with minimum of 5 years of follow-up.
A single institutional retrospective review was performed identifying patients that underwent their first Mitrofanoff revision from 2000-2014. Revisions were categorized as either superficial or subfascial. Clinical characteristics were collected regarding patients and the channels. Kaplan-Meier logRank analysis was performed to compare the revision-free survival outcomes of channels according to various factors.
A total of 84 patients were identified who underwent the initial Mitrofanoff revision during the study period. The mean age at time of initial channel creation was 8.8 years, while the mean age at initial revision was 12.5 years. Mitrofanoffs were composed from appendix (33.7%), split-appendix (24.1%), Monti (39.8%), and ureter (2.4%). Sixty three patients (75%) underwent an initial revision that was superficial. Median follow-up after initial revision was 86.5 months and 36 patients (42.9%) required repeat Mitrofanoff revision. Median repeat revision-free survival for all channels was 96 months. The superficial revisions were more likely to require a repeat revision compared to subfascial revisions (49.2% vs. 23.8%, p=0.04). There were no differences in repeat revision-free survival when comparing gender, channel type, stoma location, or type of revision (Figure 1). On survival analysis, the risk of requiring repeat Mitrofanoff revision following initial revision was 12.2% and 29.2% at 1 and 3 years, respectively.
There is a high rate of repeat revisions required following an initial revision of a Mitrofanoff channel. Patient or channel factors did not influence this risk. Subfascial revisions were associated with lower risk of requiring repeat revisions compared to superficial revision.
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